2020 Star Ratings Spotlight

CMS’ release last week of the 2020 Star Ratings gives us our first glimpse into the most recent performance data for Medicare Advantage plans across the nation.  The 2020 Star Ratings show strong signs of continued improvements in many areas.  A few notable data points include:

  • More than 50% of contracts earned 2020 ratings of 4 or more stars, up from 45%. 
  • The enrollment weighted average 2020 rating increased to 4.16, up from 4.06.
  • More than 80% of beneficiaries are now enrolled in plans with 4 or more stars, up from 75%.
  • 20 contracts earned CMS’ highest rating of 5 stars, up from 14.
  • 141 contracts earned higher 2020 ratings than they did in 2019, while only 57 saw their overall ratings drop year-over-year.
  • 56 plans earned the coveted 4th star this year, while only 21 lost their 4th star this year.

Underneath the data are many trends worth noting (and watching closely) as AEP kicks into high gear:

  • Measure stability allowed more plans to relatively easily “teach to the test.”   No new measures were added in the 2020 ratings, and changes to existing measures were largely minor, allowing many plans one last ratings cycle before potentially seismic changes take effect in both Star Ratings and MA more broadly.   The 2021 ratings (largely based on 2019 performance data) will dramatically remove the safety net of stability as plans cope with the increased weights of the patient access and experience measures, temporary retirement of several long-time HEDIS measures, and the impact of regulatory changes allowing plans to more aggressively innovate and introduce long-desired benefit flexibility.
  • National averages remained surprisingly stable.   The national average on most measures remained stable or only changed immaterially.  The stability of national average performance is a stark reminder that even when the mathematics of the Star Ratings program at a contract level shows laudable improvements, it’s quite likely that we still are not dramatically changing the broader industry. 
  • Several measures show evidence of being potentially topped out.  Three measures experienced such tightly clustered performance that there was only enough performance variation to establish 3 ratings bands (rather than the 5 normally used for measures).  Particularly as CMS continues considering adding new measures in the coming years, these measures should be watched closely as they represent likely targets for retirement.  
  • Large, publicly-traded plan sponsors were big winners.  The size, scale and organizational commitment to “doing whatever it takes to succeed” is prominently demonstrated by the performance of national sponsors.  Cigna, United, CVS/Aetna and Humana all showed strong improvements, with 2020 ratings that will satisfy investors, while Centene and Wellcare struggled amidst their impending transaction. 

READ THE CURRENT ISSUE OF RADAR ON MEDICARE ADVANTAGE WHERE MELISSA SMITH PROVIDES MORE INPUT ON THE STARS QUALITY RATINGS

Melissa Smith
Melissa Smith

Melissa Smith is Senior Vice President of Stars & Strategy at Gorman Health Group, LLC (GHG). Melissa’s team helps clients improve performance within quality ratings systems such as Star Ratings, improve health outcomes and the member experience, evaluate market dynamics and opportunities, optimize distribution channels, and supports our clients’ strategic planning needs.

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